Hello, this is Dr. Pati. We’re at capacity today so we’re going to go ahead and get started. So, today I want to welcome you to this webinar and I’m so happy that you guys are joining us. I’m going to go through a case and just show you the experience that we’ve had over the past eight years with building bone. This is one example of many but this will be a good illustrative example of to represent many that we’ve done.
So as you can see in this picture, there’s a big difference between the normal and the osteoporotic bone. Many of you may be familiar with… How do I actually change this? Okay. Maybe many of you may be familiar with that there are some indications for bone mineral density testing and the reason why I give you this list is because of the fact that we know that…
I’m actually doing testing in our patients to get a baseline somewhere in the late 30’s because we know that most bone loss actually starts somewhere in the early the late mid-30’s because of progesterone decline. Progesterone is one of the big osteoblastic builders. In men, testosterone decline because testosterone is also an osteoblastic builder, in addition, to many nutrient deficiencies that start creeping up.
So, you always should know what the indications officially are but if you look at the last one, anyone not receiving therapy in whom evidence of bone loss would lead to treatment. So pretty much that gives you a big window and an ability to order a DEXA scan which is one of the screenings that we order.
The DEXA scan indication that we put in for the diagnosis is usually height loss. You can be rest assured that height loss is an accurate diagnosis in almost anybody. So it’s not like you really have to prove it by measuring the height but we always put height loss. We found very little difficulty in getting this covered.
Another test that we do is you can measure biochemical markers of both bone formation and bone resorption. There’s many of them. The one that we like to use is the Urine NTX. It’s covered by many insurances and not covered by many insurances, but that’s one of the ones that I get routinely. I’m always looking for a number under 35 and a number under 35 represents that we’re not really losing that much bone.
When we’re in the process of trying to build bone, we’re using a model where we’re correcting multiple things. Bone loss and building bone really has to do with restoring the body to optimal. You’re restoring the optimal levels of hormones, the optimal level of nutrition, removing toxicities that are going to get in the way especially if the pH is low and acidic, you can’t build bone.
Correcting mind stressors. We know that if cortisol is high, we lose more bone. Body stressors either structural abnormalities that lead to maldistribution of weight, or structural abnormalities in the texture and the density and the strength of the bone, and the pliability. We know many times just the bone density doesn’t really correlate with fracture wrists. It’s more the condition of the bone itself.
When we’re interpreting these numbers, we’re always looking for optimal ranges. We know that in a restorative approach, in order to reach a abnormal lab value, we really have to have a number for vitamin D for example – less than 30. We know that the optimal level is going to be closer to 70. So, we’re using that number.
If you look at bone density, it’s known that for the T-score – the optimal is really +1-2. So, as we go down from +1 to 0 to -1, we’re still calling the bone normal even though we know it’s not optimal. So, I would tell you that this is the time period in which to intervene. So, if we start to see people dropping into zero or minus anything, we’re already going to use a program that’s extremely similar to the one that we ended up using in this lady.
This is TL. She’s a 57-year old woman. In 2009, she’d already been treated for almost five years for osteoporosis and also had the new diagnosis of fibromyalgia at that time. She was complaining of chronic pain pretty much all over; joints, muscles, all kinds of things. She rated her pain at about six out of ten. Her energy level she rated at three to five over ten and she was on Synthroid at 75 mcg.
Her sleep, she was waking all night long. Sleep was rated very low. She was on Nexium and we may know that any of these proton pump inhibitors is going to reduce calcium and magnesium, bioavailability absorption, carotene and B12. That was for her reflux so it isn’t enough to just put them on something that will reduce the symptoms because without correcting the underlying mucosal abnormalities, the absorption will never go back up.
She was complaining of vaginal dryness and stress urinary incontinence. This is something which most women don’t complain about outwardly unless they’re asked but if they’re asked, you can bet that most women will have some complaint in this area. Studies are actually showing that stress urinary incontinence is something which so many women wear a light pad all the time for and without asking we just would never know.
Memory of six out of ten and by the way that’s completely reversible as you’ll see in this woman. The DEXA scan, the T-score was below 2.5 on both the hip and the spine, and actually she had worsened slightly after five years of being on a bisphosphonate Fosamax. She discontinued it the year before coming into the practice because of gastric bleeding.
Just to show you, you know when we’re looking at the options that we have for treating these patients and we’re talking about hormonal replacement therapy as one possibility. I’d like you to note that hormonal replacement therapy alone which is the blue line right there and that’s without testosterone.
Then if you look at the purple line up top, that is a bisphosphonate plus hormonal replacement therapy. We can see that these carbs aren’t that far from each other but one of the things we do know is that the ability of the bisphosphonates to actually build the bone in clinical practice is much lower. When you look at it, you often see stabilization of bone density scans but to see them actually increase is much more rare.
Now, when we’re looking at some of the interventions that we will be using in this woman, we talked to her about how some of the hormones that actually build bone, progesterone, testosterone, DHEA, and Estradiol which stops bone resorption. So, these are some of the hormones that we looked at in her case.
Nutrients like a certain forms of calcium, magnesium, K2, and more of a plant-based diet which superfoods do correct the pH. Correcting the toxicities in terms of bowel inflammation, heavy metals, acid pH. I’m sure you’re getting the picture here that really in order to build bone – one has to correct the entire milieu in which the bone is actually built.
You need the builders, the building blocks, the right cement, the right pH. Even cortisol which comes from stress in the mind will start to increase the mobilization of bone and the loss of bone. Low oxygen state and lack of strength bearing exercise are two of the other components. So, getting people oxygenated and having strength bearing exercise are two of the things that we work with these patients and try to help them incorporate that into their daily routine.
As far as hormones, I didn’t give you the actual quantities in terms of the measurement status but the thing is that… So these numbers are actually based upon what you normally get from Quest and LabCorp, and in the parentheses, you see what we were looking for. So, Estradiol would be two and that would be micrograms per deciliter but in this case, I’ve just put the two.
If you look, her Estradiol was only two. The progesterone was 0.5 which is basically undetectable. We’re looking for 5-10. Testosterone of 9, we’re looking for 40-60. DHEA-S was 38 and anytime you see a DHEA-S of 38, you know this person has been under a lot of stress.
I can tell you that in her case, her stress was probably coming from the fact that she’d had about six years of chronic pain and her pain level at six was the average. She rated it as varying between sometimes a two and sometimes an eight and a nine. So you’re talking about somebody who’s been chronically stressed mentally and physically.
Her thyroid parameters revealed a free T3 of 320 and a TSH of 1.0 which really isn’t bad but if you look at the reverse T3 which was 380, which is greatly alleviated. It was clear that that 75 of Synthroid which is T4 was converting mostly to reverse T3. As you may know, reverse T3 is a direct blocking agent on the receptor site for T3. So obviously, that would be an issue also.
We started her on the following regimen. Vivelle dot which is a pathogen 17-beta Estradiol formula derived from soy; .025 is the starting dose but we increased her slowly towards the .075 mark. We started her out on progesterone 25 mg. It’s a major bone builder because it stimulates osteoblastic activity. Twenty-five mg and asked her to go up every day, every night until she slept perfectly through the night.
We started her with DHEA 25mg twice a day to help support the adrenal glands and decrease the inflammation. Synthroid we lowered from the 75 to 50 because of the reverse T3 issue and added a little bit of Cytomel which is T3 at 5 mcg to the mix. Started her on some Estriol vaginal cream at 3 mg per cc with testosterone 1 mg per cc.
That’s sort of the hormonal regimen that she was started on initially to address not only these numbers but also the symptoms that we just looked at. As far as a nutritional program, we know that the nutritional program that we would put her on would include some supplements but has to be with a great emphasis on food and especially plant-based diet with superfoods.
You may know that 500-calorie plant-based diets are going to have more calcium, magnesium, vitamin K2, and pretty much all the bone builders by about tenfold within any animal protein. So, it’s something that which we focused on. Actually in this patient, we used it later on down the line but there were some supplements we started with.
We’re looking for supplements with no preservatives, vegetable capsules and particularly, hormone activating doses of some of the nutrients like: zinc and selenium and iodine which specifically at high doses activate the thyroid, and the testosterone pathway, and active B vitamins forms, and the 5’phosphate form. Cobalt to clear bad estrogens and antioxidant doses of the vitamins.
I think that there’s many things we look for in quality control but I can tell you the one that seems to be overall most appealing to me is to make sure that the items are tested as raw materials with Spectophotometric testing because of all of the foreign and international raw material sources I think these are often contaminated. Without this kind of testing you may use a supplement as more of a toxin than something that could help you.
Spectrophotometic testing just takes the fingerprint for what you’re expecting and if you get spikes that you weren’t expecting, it will tell you that there’s something else in the mix. You know patients will always ask you, “Why should we use this versus that?” I know that you know the studies are showing that patients really prefer 85% for the doctor to recommend it.
So it helps to have some comparisons and so these are some comparisons with Centrum and GNC which are some of the most common ones. It’s interesting to note is the GNC and the Essentials 5 in 1 which are almost the same price but if you look, the doses are so different and all of the adrenal doses for B’s are actually in the Essentials 5 in 1 and aren’t in the other one.
So, it makes a big difference. Also you may know that magnesium stearate is something we’re trying to avoid and those preservatives are essentially in these other ones including dyes and so on. I highlighted vitamin K2 because vitamin K2 is one of the major active ingredients in bone preservation. So the K2 happens to be in the Essentials multivitamin which is something we use in every patient.
We’re also giving them 2000 mcg of B12 and 500 mcg of chromium for the insulin so there’s several components in here that are specifically for hormonal activation, which makes this a great formula for the things that we do with our patients. This is a comparison to other clinical lines that are used by clinicians and I think that you’ll find out.
One of the things I always get asked is about is why the calcium level here is actually low but this is calcium form that’s ionic and is utilizable by the body in any way. When you’re picking a calcium for building bone, you definitely want to have a bound calcium that can’t go and build plaque in the arteries.
Actually that’s one of the things that’s been shown, so I generally do not like to use the recommended 1200-1500 of calcium that’s recommended. I can show you what I end up using actually does build the bone which is you know really is what you’re looking for and plus we’re measuring calcium levels through Spectracell. So we know whether or not if you’re getting enough or not enough, or too much.
So, this is obviously one of the formulas we use. I like to use enteric-coated omega and I use the RxOmega because it has a 2-3 fold increase of absorption because of the enteric-coated piece. So, nutrient-wise if we look at her numbers. The vitamin D 250H was 44. We’re looking for a number above 70. The Ferritin was 9. We’re looking for a number above 90. The Urine NTX which is the N telopeptide we we’re talking about was 48, and we’re looking for a number under 35. The MCV was 100 and that tells us a little bit about possible B12 and folate deficiency.
So, these were some of the nutrient things. The urine iodine was low. So these are some of the nutrient parameters. If we wanted to get more detailed parameter on this patient, we would have gotten a Spectracell Functional Intracellular Analysis which we didn’t have on this patient. We started correcting on this alone with the Essentials 5 in 1, two capsules at breakfast and lunch. Two capsules of omega and three capsules of OsteoMD, and I’ll talk about that, twice a day.
We started her on some iodine, 12.5 mg of iodine; 10,000 units of D3 which we used for three months. So, all these things in red are the things that are going to be used temporarily. You obviously want to be very careful about making sure that your patients aren’t stuck on one million bottles of things. So, this patient will probably end up on the top three things in black but on these red things a few months.
Iron, 2 caps per day and B12 injections at 10 mg which is 10,000 mcg of methylated cobalamin with 400 mcg of folate every week. So, all of those things were eventually discontinued but this is the supplement type regimen that we started this patient on. We know that there’s quite a bit of controversy about the vitamin D.
I just showed this slide that’s produced by Osteoporosis International American Journal of Clinical Nutrition just showing what they consider to be an insufficiency status which is just below 30. A normal status which is much closer to 50 and we use more like 70. If you look at the body that actually ended up making the vitamin D recommendation earlier this year, they made their cut-off based upon nanomoles per litre at 50.
What we’ve seen is the best results keeping the patients up in the upper range and we sort aim towards a 70. We keep monitoring it so we’re not really, we use the vitamin D at 10,000 units a day for three months and then recheck it. The formula OsteoMD I was telling you about includes Microcrystalline Hydroxyapatite calcium and Anhydrous calcium aspartate, and another form of calcium.
Really if you add them up in six capsules, there’s always 600 mg of elemental calcium in here. It also has the boron, the zinc, the manganese and so on, that one would need for building bone. The thing that I want to comment on here is that we know that the bioavailability for our bones specifically of Microcrystalline calcium and calcium aspartate Anhydrous which you can see a study here just showing that…
If you look at, this is actually a randomized controlled trial showing that calcium aspartate at 500 mg, at 12 months increase the bone density 5.66. If you look at calcium citrate and vitamin D at 1500 mg, it actually showed a decline of 0.5. So with a triple the dose, you actually had a much worse effect. So, what we know is that it’s the form of calcium that matters.
So I’m never really looking for having a 1200 mg form when I’m using these bioavailable forms of calcium. This is just in comparison to some of the other things on the market. You can see the price of this one is also per month, much better. The only drawback I would say is the six pills that they have to swallow.
Since we have so many patients who have built bone on this kind of formula, I would say that this is the kind of formula that will bone build bone and patients are willing to take those when they know that that is a good option for them. Two forms of vitamin D I choose between; gelcaps and liquid. The liquid tastes a little bit bitter but I think that is a little more bioavailable. Patients do well on both of these. The iron which I use is the Bis-glycinate form of iron.
As far as iodine, the best place to get iodine from is really food sources but I also use Iosol which I very much like which brings it up very quickly. Every drop is about 2 mg and I ask them to do five drops twice a day. This is to activate the thyroid and all the other hormones, or Iodoral 12.5 mg per tablet. So, there’s all kinds of options there.
By week eight, this patient has already been seen in the middle because we saw her at week four. She was increased to Vivelle .05. She was on progesterone at 100; Synthroid 50; Cytomel 10; DHEA 25; and, Estriol testosterone vaginally. You can see she was on this pretty hefty regimen of stuff, in terms of nutrients.
Her chronic pain had gone down from a six to a three, big improvement. Her energy level that varied between a three and a five was now a six consistently. She slept all night long without waking. She was still on the Nexium and actually we hadn’t really done anything about that. At week eight, her stress urinary incontinence had gone and she wasn’t wearing a pad anymore.
That’s something which you will consistently see 85% of the time using Estriol at 3 mg and testosterone 0.5 for about eight weeks. Then we take them off and tell them to use it when they need it through the year. Memory; slight improvement. At this point, we added 5 mcg of Cytomel. We’re aiming for about a 3:1 ratio between T4 and T3. Increased the Vivelle to .075 which is about the average dose patients end up on.
This is where when she’s feeling a little better, we started working in some of the toxic stuff. The first thing we did because we need to increase her pH and get her off of the Nexium because otherwise she won’t absorb enough. So we discontinued dairy and started a plant-based program for 12 weeks in her case. She was put on a probiotic with every meal and an enzyme with every meal. So the idea is to get her off of the Nexium and that’s what the last four points are about.
We used a probiotic that hits the upper and the lower bowel. With probiotics, once you use them, you don’t need to continue to use them, unless if you’re using them and you replace the gut flora – there’s no need to use them all the time. You can use them from time to time when there seems to be a gut insult.
The enzymes we used included things for: carbohydrates, proteins, fats, cellulose, fibrin. The probiotic that I use was PureBiotic and ProbioZyme is the enzyme that we used. We asked them to use both of them with every meal, discontinue the dairy, and start on a plant-based diet. So and I’ll show you what that looks like.
As far as the toxic part, we know that the first step to detoxify the body and without this piece, I would tell you that the bone building is going to be average at best. You’re trying to reduce the burden of inhaled products, preservatives, pesticides, plastics that are endocrine disruptors, petroleum-based skin products, heavy metals. We know that heavy metals like lead and mercury will displace lighter metals like calcium and magnesium, which are needed for the bone.
Electromagnetic radiation, viruses, and parasite. We’re trying to optimize body detoxification by increasing the pH to greater than 7.0 or the morning urine pH to greater than 6.4. By increasing plants, oxygen, pure water and correcting the liver phases which you may have seen some detoxification protocols that I did in the last webinar.
We really want the bowel to move three times a day in order to mobilize all of the things that the liver is dumping into it, and the lymphatics to drain the fat tissue. So, there’s lots of little things that one does. In her case, we were aiming for a pH of greater than 6.4 AM in the urine. She was asked to avoid soda, caffeine and tea, drink pure water, breathe.
Especially her exercise routine to be an exercise routine during which she can speak. If they can’t speak during the exercise routine, it means that they’re actually not oxygenating. Plants and to correct, of course, the reflux. In her case, we considered measuring heavy metals because of what I was telling you about lead and mercury displacing magnesium and calcium.
She is 57-years old and we could have expected some decline. I’m very aggressive about checking for heavy metals if I have a very young patient with osteoporosis or osteopenia and we’re seeing this more and more. You check them and they often have heavy metal so it’s something that we’re more aggressive about in a patient in their 30’s say.
For the plant-based diet, she was asked to eat vegetables, whole grains, nuts and seeds and realize she’s already feeling better. We never put people through this phase of the program until they’re feeling better. So she didn’t really go into this part until three months after she started the original program. She said her energy was better. She’s sleeping and then she goes here.
Avoiding all meat, fish, dairy, and eggs. This is for 12 weeks. Canned, boxed, processed, refined, fried, charred, and overcooked. Now anybody could say, “Why would you just do this for 12 weeks when you know this is the ideal way to eat anyway?” The reason is because we find that by putting that 12 weeks on it, the patients are able to actually be successful at it.
What happens after the 12 weeks is a great many patients adopt a good percentage of this program for part of their lifestyle. Some people adopt it 50%, and some 60, and some 100%. So, the concept of the three months is really to get somebody regimented and we found that that 3-month period is a pretty good window in which to really allow them to have some behavioral changes that may stick for life.
We added ADD Superfoods and we usually pick arbitrarily from this list and ask them to eat the things they like and we try to teach them. We have a Superfood program where we teach them how to actually incorporate some of these into their diet. Mind-wise, we asked and I can’t tell you how important it is to bring the stressors down.
Building bone and things stress doesn’t necessarily go together. So un-committing the weekends; breath awareness; becoming the center of the universe; taking care of themselves first; giving themselves a lot of permission. We all need to do these things because it’s the only way to recover.
As far as correcting the body, one of the things I do and one to mention is that it’s really important to think about fall prevention measures in the home because in addition to giving them a good routine of exercise, there are certain things we absolutely know increase falls in homes. Things like throw rugs and not having night lights in the bedrooms, hallways, and bathrooms because people can’t see so well at night.
Removing things on the floor, the stairs. You could look at these slides. They’ll be up on the MDPrescriptives website so you can see that. I can’t tell you if you look at this list, how many people will actually come in with a fall and a fracture that has something to do with one of these things. Having frequently used items in easily reachable places.
We try to teach the patients to utilize the activities of daily living to actually get their strength bearing exercise. It seems to be an easy way at home to get something in like mopping your own floors or walking up the first three flights of steps before taking an elevator. Simple things. Standing squats while you’re watching TV.
This allows people to intergrade a certain amount into their home routine which is a much better way in terms of success rate than asking them to go to a gym or get a trainer. So, once they’ve got a little bit of a routine down, as much as they can incorporate into their lives, seems to be the way to go.
This is a slide I want to show you. I’m jumping much forward. This is at 2 years and you’ll notice that she’s still on the Vivelle .075, a progesterone of 100 mg slow-release (SR), Synthroid of 50 mcg, and Cytomel of 15. So, she’s on just about the 3:1 ratio we’ve talked about. DHEA 25 instead of the 50 we started her on because obviously her adrenal glands started recovering.
As the adrenal glands started recovering, the need for us to supplement DHEA went down. Estriol and testosterone. You can see she’s off the extra iron, off the extra vitamin D and iodine, and just on the Essentials 5 in 1, the omega and the OsteoMD. The chronic pain is gone. The energy is good. She’s sleeping all night. She’s off the Nexium. We did the plant-based diet and ended up removing the dairy and so on.
Once the gut was healed, she actually went back on a eating program where she eats some meat and some fish from time to time but definitely dairy is one of the big offenders she stays away from. There’s no stress urinary incontinence. The memory is still a seven. I guess we didn’t really make much of a budge on that.
If you look at the numbers and again, I’ve left the units out. The Estradiol is now 50 and we were looking for 50-80. The progesterone is 7.6. We were looking for 5-10. So, that’s perfect. The testosterone is a 36 from a 9. We were looking for 40-60 but she’s feeling well. So, we’ll probably leave it right there. The DHEA is now 128. Again, probably could be a little higher but she’s feeling good. So we’ll probably leave it.
I mean we all like to [indiscernible] [37:44] trump the number. The TSH is a little better at .52 The free T3 is up just slightly at 360 but you can see the reason why she’s feeling better. It’s because the reverse T3 which is a blocker which was at 380 is now at 240. So, she’s really freed up a lot of those receptor sites and it just has more activity at the T3 level.
The vitamin D is now 68. We’re aiming for about 70. So, this is pretty good. She’s not on the vitamin D3 anymore. She’s on 2000 units between the Essentials and the OsteoMD. She’s on 3000 total units and that ends up being a reasonable maintenance dose. The only time we ask people to kick it up is when they’re being exposed to colds or viruses. The Urine NTX, we’re looking for a number under 35.
She’s now 28. She was 48 and losing bone. So, this is good. The DEXA scan in May of 2011 which was really just a few weeks ago, showed normal mineralization. That means that the spine T-score had come up to a 0.2 which means it had actually gone through a +2.7 deviation. Hip T-score was -0.6.
So, it’s still minus so we would still be aggressive to get that minus gone and really put that into a +1 range is where we would aim for, but this is a 2-year from osteoporosis to normal mineralization. So, if you look at some of the interventions that we use there wasn’t one thing or the other thing that actually corrected it. It was a combination of things.
I want to thank you very much for your attention. This is the end of this webinar and I can take some questions. If you want, I guess you should type them. I see some questions so I’ll just read the question out and continue. Okay, the first question. Will these slides be made available? They’ll be available on MDPrescriptives website along with the webinar.
I have previously tried to get the slides on the website but have had problems with other webinars. So, this is something which we need to obviously address. Okay, so we have a contact customer service number for… So, I would contact them. The name of the person who’s in charge of that is Kate. So, I would absolutely contact them because there’s a reason why we’re putting the slides on so you can have access to them. So I really would like you to have access to them.
Putting women under 25 mg of DHEA won’t convert to undesired estrogen? That’s the next question. We are very careful with DHEA. We actually limit usually in women DHEA doses to 25 and in men to 50. So, that’s a good question that it can convert. In a woman who has every sign that she has adrenal fatigue and remember this woman was diagnosed with fibromyalgia and her DHEA level was 38.
Where you’re looking for somewhere in the 150-200 range which means that she was actually producing only at 15-20% of normal optimal activity. So, it’s very safe in her case to give her 50 mg until she corrected it. As you saw even on the 25 mg she really wasn’t very high on the DHEA. It come to 128.
What is the time interval for lab test to control this type of patient? Usually every three months. When they feel well, we usually do every six months. Let’s see here. Next question. We test all patients, by the way, every six months for a lab test. When we’re trying to correct them initially, we use every three months.
What adrenal products do you like for adrenal fatigue? At the moment, again there’s a whole lot of things that we’re actually using for adrenal fatigue. A hormonal regimen which is similar to actually the one you see here. A nutritional regimen which is going to include magnesium glycinate which I get from Premier Labs. Adaptogen and Adrenal Complex which I also get from them.
So, routinely I would put people on that and something called Vitality C which comes from American Biologics. Give them four grams of vitamin C along with the Essentials and the Omega, and B12 injections. So, those are sort of the seven things that one uses for an adrenal patient upfront and then over time you can bring it down because those patients don’t want too many.
Is Urine NTX test covered by insurance? It used to be covered more reasonably by insurance now. In some patients, especially with Medicare we’re getting a little bit of trouble. We find that height loss sometimes takes care of that problem and we pretty much circle height loss in everybody because everybody has height loss or osteopenia or osteoporosis, if they have that diagnosis. Next question.
What I can do with a patient that’s not able to tolerate pills due to severe gastritis? I wouldn’t give them any pills to swallow until you correct the gastritis. Now, every single thing that goes through their mouth should be for particularly correcting the gastritis which means it should be healing every food and every supplement. So, the things that you should be putting them on is a completely plant-based diet for 12 weeks with probiotics, enzymes aloe arborescence, and glutamine.
Those are the four things that 85% of the time will correct gastritis and of course, you also have to rule out bugs like h-pylori and such. Okay, next. We have had one person on OsteoMD who had headaches was taking it. Stopped and restarted to verify. Do you have any thoughts about what might be triggering the headaches?
So, headaches are something that usually comes from vascular instability. Vascular instability is usually a result hormonally of Estradiol and progesterone fluctuations; nutritionally magnesium and calcium fluctuations; toxic-wise, it could be due to heavy metals or acidic pH. So there’s lots of pieces to that that can give you vascular spasm and give you headaches.
So in OsteoMD, if it’s actually the cause of it, it’s probably because of either the magnesium or the calcium. What I would suggest is that this person’s progesterone and Estradiol, if it’s a woman, always take a look at it. Once those stabilize, I usually don’t actually start them on OsteoMD upfront. I usually do the Estradiol or the progesterone first then give them the Essentials and the Omega.
Those are all vascular stabilizers. So once you get the vascular system stabilized, it becomes a lot easier to put on other things. So, I would probably reverse the order in which you’re doing things unless you’ve already done that. What do you do when patient has osteoporosis uses Vivelle .025 has a Serum of 260 and a NTX of 48, and cannot tolerate higher Estradiol without serious breast tenderness?
So, in this patient there are a lot of other pieces of the puzzle that one might consider in order to build bone. For example, you may consider if DHEA is low. A restorative approach is going to be taken to physiologically bringing everything back into balance. So Estradiol should be maintained somewhere between 50-80 but you really can’t do any better than where you are so I would leave that right there.
I would add the progesterone because it’s the major osteoblastic stimulator. Even if she has a hysterectomy, all the rest of the body including the bones and the brain need the progesterone. I would correct DHEA to the 150 mark and then use the OsteoMD and get the pH alkaline. Those would be the big you know again, using the model, each piece should be corrected.
I actually think the Estradiol of 60… I don’t know the age of this patient, but an Estradiol of 60 usually cannot be achieved with a Vivelle dot of .025 which means this patient has residual Estradiol and ovarian activity; which means she’s probably swinging up high and swinging up low. So, I think that you know we might want to reconsider that and go towards progesterone. Do you ever do salivary cortisol and secondarily use Cortef without salivary testing?
Yes. I do salivary cortisol tests when I feel the patient needs confirmation or I’m confused. But if it looks like a straightforward case of adrenal insufficiency based upon a DHEA that’s very low or undetectable or very low cortisols and a very good history of stress, and symptoms that correspond with the adrenal insufficiency – I will use Cortef and start a 2.5, and ask them to increase it every few hours until they get to feeling better.
Next one. A patient with Tamoxifen and severe osteoporosis, can I try her like a regular patient or the Tamoxifen has any contraindication? The fact is that the Tamoxifen really adds very little to her regimen if she’s using it for breast cancer prevention but if that’s the reason she’s on it, you’re certainly are not going to use Estradiol. You can use progesterone.
What’s going to happen to the patient, she’s going to be stuck between the collagist and you defending her choice to use progesterone but still it’s worth having that discussion of progesterone, testosterone, DHEA and then all the rest of the model. All the rest of the model. I can tell you that her chance of dying of the severe osteoporosis is much greater than her chance of dying from a recurrent breast cancer.
That’s actually published and shown in Goodman’s article which was published in The New England Journal of Medicine when they re-analyzed Women’s Health Initiative Study. Personal question. Six months ago I had a testosterone level of 69 and now 40. Could this be due to adrenal fatigue?
It’s not that much of a variation. It could be because of adrenal fatigue. It could be because there isn’t a lot of progesterone onboard. There’s many possibilities and it just could be a variation. It can be the ups and downs. I mean these numbers are not always going to sit in the same place and I don’t think 69 and 40 are really that different at the end of the day.
I would go with the clinical picture, though. If the clinical picture is good, I wouldn’t even look at the lab value. I’ve had a number of patients on Armour come back with decrease in TSH numbers but no change in T3. Any idea why?
The why I cannot give you. However, and of course, you know that if they take their Armour early in the morning before they get their lab tested, it’ll be detected. But if they took it the day before and held it before you did the lab testing, it will not be detected because T3 from Armour only lasts in the body for 4-6 hours. So, TSH is suppressed over a 24-48-hour period of time.
So, if your patient didn’t take the thyroid the morning they were tested, there may be no change in T3. The more important thing is with the clinical presentation. If the patient is having good energy, good mental clarity, good memory, focus, concentration, and all of that – you can obviously keep the Armour right where it is. If not, then you have to correct it with either more Armour or just adding T3 in the form of Cytomel. If the adrenals are strong or in the form of T3 slow-release.
At the Vegas Web Shop you mentioned not to start progesterone and DHEA at the same time because of acne and hair loss; start progesterone first. How do you decide this? I usually do start progesterone first in a woman and actually progesterone makes DHEA quite well. So in a lot of these women, you don’t even need DHEA and the less pills they have to swallow – the better.
I have an 80-year old male with chronic IBS for 10-12, I guess that means years. Diarrhea stools. Okay. No relief with any meds. Brief relief with some energy treatment like visceral manipulation for 6-8 months and previous relief with hydrocodone. What approach would you take?
The very first approach I would take is to remove every single thing that goes through the mouth that’s going to be irritating to the bowel and only put the ones that are not going to irritate the bowel. So the very first thing to do is again a 12-week plant-based program and I’ve used this in so many chronic IBS, ulcerative colitis, and Crohn’s patients that I can tell you with security that this is the way to go.
In 80%+ of these patients, it will relieve it and correct it. In some percentage of the patients, you’re going to need to do some more testing that I can talk to you about at a later webinar. The first thing to do is to use the bowel regimen which is: plant-based diet, no dairy, no meat, no fish, no eggs; probiotic three times a day; enzymes three times a day; aloe arborescence, 2 oz three times a day; glutamine, 2 g three times a day. That’s the very first to do.
It will lower the inflammation of the gut and then you can work from there. What AM cortisol level do you shoot for? So, the AM cortisol level in the Serum isn’t very accurate. It depends and varies very much upon how you slept. It reflects your ability to recover your adrenals in the sleep. If you have a very unstressed person who has absolutely nothing going on, a 10- a 14 would be a great number.
If that person tells you that they have a lot of stress going on and they have all the adrenal fatigue-type symptoms, you can be rest assured that a 10 is way too low and that person is showing you adrenal insufficiency. Recently, some of my patients have been gaining weight after starting progesterone. Any comments?
They will often have this and once you correct the metabolism through the thyroid. I put them on the Essentials and the B12, and get their metabolism kicked up – it goes away. So you can imagine that obviously if all our patients got fat on hormones, we wouldn’t have any. So, just over time it absolutely corrects.
Do you have any experience with energetic medicine and association with this scheme? Absolutely. We have a couple of different energetic forms of medicine that are in our practice. We use them in about 10-20% of our patients including acupuncture and craniosacral, and within we have also quantum reflex analysis testing that we use in some percentage of our patients. We don’t have bioresonance or biofeedback as of yet but those are excellent methods.
So, at this point I’m going to be concluding the question part of this and I hope you had an excellent time learning at some things. If there’s anything else that you want to ask, you can send those questions through MDPrescriptives and I will try to answer them as soon as I can. So, have a great evening and we will be announcing our next webinar within the next few…